Successful surgical retrieval of Celt ACD® vascular closure device embolised in the tibioperoneal trunk

Abstract

BackgroundThis report presents a case of surgical retrieval of a Celt ACD® vascular closure device (VCD) situated in the tibioperoneal trunk, following a failed attempt at deployment. Existing literature mostly recommends an endovascular approach when attempting to retrieve embolised VCDs.Case presentationA 55 year old male presented with right sudden right lower limb pain and numbness 1 week following a successful left retrograde superficial femoral artery (SFA) angioplasty. Computed tomography (CT) angiogram revealed that the Celt ACD® VCD had embolised in the right tibioperoneal trunk. An endovascular approach was initially attempted to retrieve the VCD; however, this was unsuccessful due to the small diameter of the target artery. Due to the failure of the endovascular approach, surgical exploration of the right tibioperoneal trunk was undertaken, which led to the successful retrieval of the embolised VCD.ConclusionThe case presented herein demonstrates the critical need for swift and decisive surgical exploration of patients with suspected embolisation of Celt ACD® devices in smaller distal arteries. Our experience has led to the recommendation that, due to the sharp edges of the Celt ACD® accompanied with the small diameter of the occluded vessels, surgical exposure and retrieval is the safest option if endovascular retrieval is unsuccessful.

A novel double clip-based vascular closure device in antegrade and retrograde femoral punctures: A single-center experience in peripheral non-cardiac procedures

“…The endoluminally-anchored part of the implant poses the risk of intravascular device migration with luminal obstruction and flow limitation. [16][17][18] Furthermore, the device proved inapplicable in acute vascular access angles between 70° and 90°, occurring in antegrade approaches. Thus, we suggest ultrasound guidance for the initial antegrade puncture, in order to achieve an access angle of less than 50°.…”

Endovascular Management of Superficial Femoral Artery Occlusion Secondary to Embolization of Celt ACD® Vascular Closure Device

“…Complications related to the failure of deployment or embolization of VCD usually occurred and were observed periprocedurally or within days postdeployment [ 1 , 7 ]. To the best of our knowledge, late presentation, months after deployment, has not been reported in the literature.…”

“…Upon discovery of the embolization of a VCD during deployment, it should be immediately managed either by endovascular snaring or open surgical retrieval [ 1 , 5 , 9 ]. However, symptomatic chronic embolization should be managed either by angioplasty or open surgical repair, as there is no chance for endovascular retrieval since the device will be embedded in the wall, possibly due to endothelialization and intimal hyperplasia.…”

“…Currently, vascular closure devices (VCDs) are widely used in endovascular surgery [ 1 ]. VCD achieves faster hemostasis at the access site, and allows prompt recovery and early mobilization after intervention [ 2 ].…”